Leadership practices and maternal and child health outcomes in Sub-Saharan Africa: a systematic review

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Abstract Background Maternal, newborn, and child health (MNCH) remain a major public health challenge in Sub-Saharan Africa (SSA), where preventable mortality persists despite global commitments to reduce deaths. Weak leadership and management within primary health care (PHC) systems contribute to inefficiencies, inequities in access, and suboptimal quality and continuity of care. Methods This systematic review examined how leadership and management practices influence MNCH outcomes in SSA. The systematic review followed PRISMA 2020 guidelines and was conceptually informed by the WHO Health System Building Blocks framework and governance-oriented leadership concepts. Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, CINAHL, Embase, Google Scholar, and the WHO African Index Medicus (AIM) for peer-reviewed studies published between 1978 and July 2025. The protocol was registered in PROSPERO (CRD42024514304). Clinical trial number: Not applicable. Studies were eligible if they examined leadership or management practices in PHC settings and reported MNCH outcomes. Results Thirteen studies from seven countries and one multi-country analysis met the inclusion criteria. Leadership approaches clustered around three domains: leadership capacity building and supportive supervision, participatory and accountable governance, and community engagement mechanisms. These approaches were consistently associated with measurable improvements in service coverage and quality. Reported gains included increases in antenatal care utilization (+ 12% to + 48%), skilled birth attendance (+ 10% to + 34%), and immunization completion rate (+ 8% to + 27%). Management practices including mentorship, routine monitoring, and data-driven decision-making strengthened provider performance, coordination, and service delivery efficiency. Conclusion Leadership and management are critical system-level drivers of PHC performance and MNCH outcomes in SSA. Strengthening leadership and management capacity within PHC systems represents a high-impact strategy for improving service delivery and accelerating progress toward MNCH targets in SSA.